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| Plan Name | FLORIDA BLUE |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ACTIVUS CONNECT LLC |
| Employer identification number (EIN): | 831917754 |
| NAIC Classification: | 561420 |
Additional information about ACTIVUS CONNECT LLC
| Jurisdiction of Incorporation: | Florida Department of State Division of Corporations |
| Incorporation Date: | 2018-09-13 |
| Company Identification Number: | L18000218000 |
| Legal Registered Office Address: |
8160 Chilton Dr ORLANDO 32836 |
More information about ACTIVUS CONNECT LLC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-03-01 | MINERVA SERRANO | 2023-10-17 | ||
| 501 | 2021-03-01 | MINERVA SERRANO | 2022-09-27 |
| Measure | Date | Value |
|---|---|---|
| 2022: FLORIDA BLUE 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-03-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 149 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 149 |
| Number of employers contributing to the scheme | 2022-03-01 | 0 |
| 2021: FLORIDA BLUE 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-03-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 118 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 118 |
| Number of employers contributing to the scheme | 2021-03-01 | 0 |
| 2022: FLORIDA BLUE 2022 form 5500 responses | ||
|---|---|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: FLORIDA BLUE 2021 form 5500 responses | ||
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | First time form 5500 has been submitted | Yes |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |||||||||||||||||||||||
| Policy contract number | J3228 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |||||||||||||||||||||||
| Policy contract number | J3228 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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